Aims Mahaim‐type accessory pathways (MAPs) are generally right‐sided due to the embryological differentiation, but left‐sided localization is also possible. This study aims to compare the clinical and electrophysiological characteristics of right‐ and left‐sided MAPs. Methods Of 251 patients diagnosed with AP by electrophysiological study between November 2015 and February 2020, 12 patients with MAP were included (right sided n = 8, left sided n = 4). MAP was diagnosed if; (1) no retrograde conduction; (2) anterograde decremental conduction; (3) adenosine sensitivity; and (4) Mahaim potential at successful ablation site were present. Results Ten of twelve MAPs were clustered on the lateral walls of the mitral (n = 3, 75%) and tricuspid annuli (n = 7, 87.5%). Right‐sided MAPs were mostly long pathways extending toward the conduction system whereas left‐sided MAPs were short extending toward the neighboring myocardium. For right‐ and left‐sided APs, the median QRS times were 129 and 156 ms (p = .042), the median VAbl‐RVApex intervals were −12 and 64 ms (p = .007), the median QRS‐V(His) intervals were 16 and 86 ms (p = .120), and the median VAbl‐QRS interval was −8 and 12 ms (p = .017), respectively. Coexistence of dual atrioventricular node physiology was observed only in right‐sided APs (n = 3, 37.5%). Conclusion MAPs are more typically located on the right but may rarely be seen on the left. Catheter ablation was associated with high success without complications.

Upper venous system anatomic variations may cause difficulties during cardiac pacemaker implantation. Persistent left superior vena cava (PLSVC) and absent right superior vena cava could be an arrhythmogenic source of atrial arrhythmias and cardiac conduction disease. We represent dual-chamber pacemaker implantation in a patient with a very rare upper venous system anomaly, paroxysmal atrial fibrillation, sick sinus syndrome, that cause unusual fluoroscopic image.

ST‐elevation myocardial infarction (STEMI) is a life‐threatening clinical condition that requires immediate intervention, mostly caused by complete occlusion of epicardial vessels. Other diseases such as myocarditis, pericarditis, electrolyte disturbance, and early repolarization may mimic. We present a rare case of atrial lead‐related atrial perforation which mimics inferior STEMI.

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Background Wolff‐Parkinson‐White (WPW) syndrome is one of the most common congenital cardiac abnormalities among ventricular pre‐excitation syndromes. Radiofrequency catheter ablation (RFCA) treatment of accessory pathways (APs) in WPW patients is an established curative therapy restoring normal atrioventricular conduction. We have not encountered any studies evaluating both the LA and LV functions of these patients before and after RFCA with three dimensional‐speckle tracking echocardiography (3D‐speckle tracking echocardiography (STE)). Aim The purpose of the current study was to assess the LA and LV functions in patients with WPW syndrome before and after RFCA using 3D‐STE. Methods A total of 21 patients with WPW syndrome who had been scheduled for RFCA were prospectively recruited for this study. 3D‐STE examinations of the patients were performed 12–24 h before ablation and 1 month after ablation. Results The LV‐global longitudinal strain (LV‐GLS) and LV‐global circumferential strain (LV‐GCS) were significantly depressed in the pre‐RFCA WPW group than in the control group (−14.3 ± 2.1 vs. −21.5 ± 2.2, p < .001; −12.6 ± 1.8 vs. −20.4 ± 1.8, p < .001, respectively). The left atrial strain‐reservoir (LAS‐r) and LAS‐active were significantly decreased in the pre‐RFCA WPW group than in the control group (31.9 ± 2.4 vs. 48.8 ± 2.6, p < .001; 11.7 ± 2 vs. 26.5 ± 2.1, p < .001, respectively). The LV‐GLS, LV‐GCS, LAS‐r, and LAS‐active values improved after RFCA compared to before. Conclusion The results of our study indicated that there are subclinical impairments in LV and LA myocardial dynamics in the apparently healthy WPW patients, and these deteriorations improve after RFCA of AP.